Manila Bulletin

The answer to cancer

Is metformin an anti-cancer drug?

- DR. KAYCEE REYES

Cancer isn’t the first word that comes to mind with the mention of metformin. Diabetes is, as it should be. Type

2 diabetes is the most common form of diabetes that results in a rise in sugar levels due to insulin resistance, and metformin is the primary medication prescribed to manage the disease. Metformin maintains blood sugar levels by lessening the production of glucose and makes cells more responsive to insulin. With its continued research through the years, more benefits have been discovered for metformin that outweighs the side effects, such as the treatment for Polycystic Ovarian Syndrome (PCOS), reduction in incidence of Parkinson’s Disease, and dementia, and now, even as a possible treatment for cancer. Is metformin the anticancer wonder drug? French lilac (Galega officinali­s) or “gold’s rue” is a medicinal herb that has been used for centuries. This plant contains a compound that can control blood sugar levels, leading to the discovery of metformin in the early 1920s by Dublin chemists Dublin Emil A. Werner and James Bell, biochemist­s Karl Slotta and R. Tschesche, and Filipino physicist Eusebio Y. Garcia after confirming its blood-sugar lowering abilities by testing it on animals. Soon after, in the 1950s, it was tried on humans and had its results published by French diabetolog­ist Jean Sterne, calling it glucophage or glucose-eater. It was introduced to the United Kingdom and Canada in the succeeding decades, until it eventually received US Food and Drug Administra­tion approval in the mid 1990s for the treatment of Type 2 diabetes.

Metformin is generally safe to take and usually has tolerable side effects that should go away in time, such as weight loss, headache, stomach pain, nausea or vomiting, gas, diarrhea or constipati­on, among others. The most serious risk is lactic acidosis, which is rare but needs immediate treatment. Aside from Type 2 diabetes, metfromin is also being used as treatment for PCOS, prediabete­s, and gestationa­l diabetes. But as more research comes to light, metformin is now also being linked to weight loss, Parkinson’s Disease and dementia, nicotine withdrawal, and even cancer.

It is well-known that cancer risk increases with weight gain. This is why obese individual­s and diabetics have a significan­tly higher risk for almost all cancer types compared to their non-diabetic counterpar­ts. This connection between diabetes and cancer has led to more research on the link between metformin, arguably the most popular, generally safe, and inexpensiv­e diabetes treatment, and cancer prevention.

Metformin works at the molecular level that affects the enzyme adenosine monophosph­ate-activated protein kinase or AMPK that, when activated, is responsibl­e for regulating metabolism, dictating its energy storage and use, and helping with cellular growth and death. Because cancer cells multiply exponentia­lly at a rapid pace, this regulation done by the activation of AMPK is what inhibits cancer cells to thrive by starving these cells as it disrupts its process of developmen­t. AMPK is naturally activated by our bodies through exercise and caloric restrictio­n. But recent studies have also shown that those who take metformin have a reduced risk of breast, colorectal, stomach, and pancreatic cancer as compared to non-diabetics. Moreover, those who eventually had cancer still had a higher rate of surviving the disease, and that the earlier the metformin regimen was taken, the higher anti-cancer benefit it provided. More interestin­g is that studies are also looking at healthy individual­s taking metformin as an anti-cancer drug, with promising results shown to reduce risk of colorectal, lung, and breast cancer.

Right now, metformin is only US FDA approved for the treatment of Type 2 diabetes, and while it also shows anti-cancer potential, more tests and studies are still needed to further support previous trials. While it is not the answer to cancer, at least as of now, let us hope that metformin research will lead to the right answer in the future.

Aside from Type 2 diabetes, metfromin is also being used as treatment for PCOS, prediabete­s, and gestationa­l diabetes. But as more research comes to light, metformin is now also being linked to weight loss, Parkinson’s Disease, dementia, nicotine withdrawal, and even cancer.

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